By Katie Dahlstrom
Clinton firefighter paramedics were not told to code every ambulance to run at a higher rate no matter what, EMS Director Andrew McGovern testified Wednesday.
McGovern returned to the stand Wednesday as the city's legal malpractice suit against attorney Michael Walker and his law firm Hopkins and Huebner continued.
Walker represented the city in a federal False Claims Act suit brought on by whistleblower Timothy Schultheis in 2008. The city claims Walker failed to properly analyze the case and his alleged negligence led to the city settling for $4.5 million in 2010.
Schultheis claimed the city, at the direction of the EMS Director, McGovern and former fire chief Mark Regenwether, knowingly, deliberately or recklessly submitted false claims to the U.S. government in order to get higher reimbursements from Medicare and Medicaid for its emergency medical services.
At issue throughout the legal malpractice suit has been the city's use of the advanced life support code instead of the basic life support code, the former yielding the higher reimbursement rate.
When Schultheis testified last week, he said McGovern told firefighter paramedics to code all patient care reports ALS and to use oxygen, heart monitor and IV's on all patients transported by the city ambulance.
Theses assertions were not true, McGovern testified.
Coding was done according to a number of guides, including those from Medicare, the American Ambulance Association and the firm Page, Wolfberg and Wirth, McGovern said. Douglas Wolfberg of Page, Wolfberg and Wirth was retained by the city as an expert for the Schultheis case.
While the city had a 99 percent ALS rate for Medicare claims during the period under scrutiny, this did not surprise McGovern given the elderly population in Clinton, he testified.
He believed the fire department was being accurate when completing patient care reports, which he told Schultheis during the two conversations they had about coding prior to the False Claims Act case being filed, McGovern testified.
McGovern told the jury that contrary to Schultheis' account that he had brought his concerns about the coding procedures forward to McGovern six times, only two conversations about coding occurred between the two.
The first was during a class McGovern was teaching a shift of firefighter paramedics about patient documentation, which included telling them to be as accurate and detailed on patient care reports as possible, McGovern said.
Schultheis asked how an ambulance run could be coded as ALS when only a BLS skill was used. McGovern said he directed Schultheis to the ALS assessment rule. According to that rule, ALS requires an emergency response and an ALS assessment or an ALS intervention.
The second conversation occurred sometime later, at the end of 2007 after Schultheis' supervisor, Battalion Chief Joel Atkinson, told Schultheis to direct his coding concerns to McGovern.
Schultheis told McGovern he felt the department was over-coding the mode of transport, McGovern said. McGovern tried to reason with Schultheis about the coding by using the various training guides and the Medicare guide, he testified.
At that point Schultheis became "agitated" and "upset" and began yelling, McGovern said.
"He said he was right and we were wrong; he wasn't going to lose his paramedic license because of us," McGovern said.
McGovern testified he told Schultheis to put the concern in writing so he could follow through on the complaint. Both McGovern and Schultheis testified no complaints were ever made in writing.
During the course of the False Claims suit McGovern was sent to further seminars on coding and maintained his belief that the city was coding properly, he said.
When he learned the city had settled the case in September 2010 he was shocked because, he testified, the fire department had consistently and accurately applied the coding rules dictated by Medicare and other guides.
"We did not see where there was a problem," he said.
McGovern's testimony will continue Wednesday afternoon.